FIRE (Facilitating Implementation of ResearchEvidence): a study protocol

Background: Research evidence underpins best practice, but is not always used in healthcare. The PromotingAction on Research Implementation in Health Services (PARIHS) framework suggests that the nature of evidence,the context in which it is used, and whether those trying to use evidence are helped (or facilitated) affect the useof evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, andis a key priority within European health and social care policy. Improving continence care has the potential toimprove the quality of life for older people and reduce the costs associated with providing incontinence aids.Objectives: This study aims to advance understanding about the contribution facilitation can make toimplementing research findings into practice via: extending current knowledge of facilitation as a process fortranslating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of twodifferent models of facilitation in promoting the uptake of research evidence on continence management;assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing apro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practicecommunity.Setting and sample: Four European countries, each with six long-term nursing care sites (total 24 sites) for peopleaged 60 years and over with documented urinary incontinenceMethods and design: Pragmatic randomised controlled trial with three arms (standard dissemination and twodifferent programmes of facilitation), with embedded process and economic evaluation. The primary outcome iscompliance with the continence recommendations. Secondary outcomes include proportion of residents withincontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes areassessed at baseline, then at 6, 12, 18, and 24 months after the start of the facilitation interventions. Detailedcontextual and process data are collected throughout, using interviews with staff, residents and next of kin,observations, assessment of context using the Alberta Context Tool, and documentary evidence. A realisticevaluation framework is used to develop explanatory theory about what works for whom in what circumstances.Trial registration: Current Controlled Trials ISRCTN11598502.